Adjustable cervical collar

ABSTRACT

An improved cervical collar comprised of an elongated neck encircling band, a chin support brace, a sternum and shoulder brace and an adjustment system secured to the sternum and shoulder brace and the elongated neck encircling band for adjusting the height of the sternum and shoulder brace in relation to the elongated neck encircling band. The adjustment system is designed to lock the sternum and shoulder brace in position preventing further extension of the sternum and shoulder brace in relation to the elongated neck encircling band as well as preventing retrograde movement of the sternum and shoulder brace in relation to the neck encircling band. The collar also comprises a positive alignment tracking system for maintaining the sternum and shoulder brace in parallel alignment with the elongated neck encircling band as the height of the sternum and shoulder brace is adjusted. In an alternative embodiment the sternum and shoulder brace is an integral part of the elongated neck encircling band and the chin support brace is secured to a chin support height adjustment piece which is slidably secured to the elongated neck encircling band such that the height of the elongated neck encircling band and the sternum and shoulder brace are adjustable together and independent from the chin support height adjustment piece.

This application is a continuation application of U.S. application Ser.No. 08/652,936 filed on May 24, 1996, now U.S. Pat. No. 5,728,054, whichwas a continuation application of U.S. application Ser. No. 08/199,366,filed on Feb. 18, 1994, now U.S. Pat. No. 5,520,619, which was acontinuation-in-part application of U.S. application Ser. No.08/064,221, filed on May 20, 1993, now U.S. Pat. No. 5,366,438.

BACKGROUND OF INVENTION

1. Field of Invention

This invention relates to cervical collars. More specifically thisinvention relates to a cervical collar with an adjustable sternum andshoulder brace.

2. Prior Art

Numerous types of cervical collars have been disclosed which aredesigned to restrict the movement of the head and neck of a person whohas suffered a neck or spinal injury. In fact, cervical collars are nowstandard equipment for emergency medical service squads and rescueunits.

Originally cervical collars were constructed from relatively heavystrap-like materials such as leather or other such heavy duty materialsand usually included a number of metal braces. See, for example, U.S.Pat. No. 3,027,894. These bulky cervical collars were reasonablysuccessful in immobilizing the head but presented significant problemswhen x-rays were needed because of the metal contained within thebraces. In addition, these bulky cervical collars did not provide accessto the patient's neck if a tracheotomy was necessary. Finally, becauseof the materials commonly used to manufacture these bulky collars, theywere cumbersome to use and expensive to produce. Because of current andanticipated limitations on reuse of virtually all medical products,expense is now a significant factor in the choice of all medicalequipment which may be exposed to body fluids, including specificallycervical collars. Thus, these bulky cervical collars are now tooexpensive as single use, medical products.

As a result of the enhanced utilization of lighter weight, plasticmaterials, cervical collars are now generally constructed fromrelatively stiff, light-weight plastic materials that are capable ofbeing bent to encircle the neck of the wearer and yet still providesubstantial support for the wearer. Examples of these types of collarsare disclosed, for example, in U.S. Pat. Nos. 5,083,553, 5,060,637 andU.S. Pat. No. RE. 32,219.

In emergency medical situations, it may be necessary to install a lowcost, cervical collar on individuals of varying sizes. For example, acervical collar may be necessary for a child of small size or a largeadult. As a result, it is important that the size of the cervical collarbe adjustable and yet still effectively immobilize the neck of thepatient. This problem has been partially addressed by providingdifferent size cervical collars for different sized individuals.

When placing a cervical collar on an injured individual, it is alsohelpful to put the cervical collar in position behind the patient andthen adjust the frontal portion of the cervical collar to immobilize theneck of the patient regardless of the patient's size. As a result, anumber of cervical collars have been designed which permit the necksupporting piece or sternum and shoulder brace to be expanded to bettersupport the patient's neck. Early models of these cervical devices suchas U.S. Pat. Nos. 3,024,784 and 3,060,930 allow for the verticalextension of the neck supporting piece or sternum and shoulder brace ofthe cervical collar utilizing conventional construction. In addition,modest adjustments to the location of the neck piece of a cervicalcollar have been disclosed more recently in U.S. Pat. Nos. 4,520,801 and5,180,361.

A common element of cervical collars and also cervical braces arestructural designs for adjustment of the position of the neck support ofa sternum and shoulder brace or cervical collar. In cervical braces abrace element is placed around the shoulders of the patient, a neckpiece is placed under the patient's neck and the distance between thosetwo is adjusted by adjustment means such as screw and bolt, pins andother such adjustment devices. See, for example, U.S. Pat. Nos.2,102,069, 2,736,314, 3,024,784, 3,306,284, 3,724,452, 4,515,153,4,628,913 and British Patent Nos. 1,132,607 and 2,233,900. Other commonmethods for adjusting the height and placement of the neck piece of acervical collar have also been disclosed, for example in U.S. Pat. Nos.2,828,736, 3,027,894, 3,042,027, 3,295,516, 3,220,406, 3,313,297 and3,916,885.

While many of these patents disclose devices which have neck supportpieces or sternum and shoulder braces that are adjustable, they are noteasily adaptable for placement around the patient in an emergencymedical situation. In addition, these devices do not provide adjustableneck support pieces which can be adjusted in height while the backportion of the cervical collar is held in place against the patient'sneck. Further, these devices fail to provide adjustable neck supportpieces that can be locked in position thus preventing the patient fromcollapsing the cervical collar after it is installed in place. Further,the disclosed devices for adjusting the neck support or sternum andshoulder brace fail to permit parallel adjustment to both sides of necksupport or sternum and shoulder braces automatically.

Therefore, it is an object of this invention to provide an improvedcervical collar.

It is a further object of this invention to provide a cervical collarwith an improved sternum and shoulder brace for said collar.

It is a still further object of this invention to provide an improvedcervical collar whose neck sternum and shoulder brace can be adjusted.

It is a still further object of this invention to provide an improvedcervical collar with an adjustable sternum and shoulder brace which canbe locked in a fixed position.

It is a still further object of this invention to provide an improvedcervical collar with an adjustable sternum and shoulder brace whichprovides positive parallel adjustment to both sides of the sternum andshoulder brace automatically.

It is a still further object of this invention to provide an improvedcervical collar with an adjustable sternum and shoulder brace which canbe adjusted in height while the back portion of the cervical collar isheld in place against the patient's neck.

It is a still further object of this invention to provide an improvedcervical collar with an adjustable sternum and shoulder brace and a chinsupport brace wherein the chin support brace can be adjusted in heightwhile the back portion of the cervical collar and the sternum andshoulder brace are held in place against the patient.

These and other objects and features of the present invention willbecome apparent to those skilled in the art from a consideration of thefollowing detailed description, drawings and claims. The description,along with the accompanying drawings, provide selected examples of theconstruction of the device to illustrate the invention.

SUMMARY OF INVENTION

In accordance with the present invention there is provided an improvedcervical collar comprised of an elongated neck encircling band, a chinsupport brace and an adjustable sternum and shoulder brace with anadjustment system means for adjusting the height of the sternum andshoulder brace in relation to the elongated neck encircling band. Theadjustable sternum and shoulder brace can be adjusted in height inrelation to the chin support brace and can be locked in a fixed positionto support the neck of the patient. While the preferred embodimentutilizes a separate elongated neck encircling band, chin support braceand adjustable sternum and shoulder brace, the chin support brace may beformed at the same time as or formed as an integral unit of theelongated neck encircling band.

In an alternative embodiment the present invention is an improvedcervical collar comprised of an elongated neck encircling band whichincludes as an element thereof a sternum and shoulder brace, a chinsupport height adjustment piece, a chin support brace secured to saidchin support height adjustment piece and an adjustment system means foradjusting the height of the chin support brace in relation to theelongated neck encircling band. The height of the chin support brace canbe adjusted in relation to the elongated neck encircling band and thenlocked in a fixed position to support the neck of the patient.

This invention will now be described with reference to the accompanyingdrawings in which

FIG. 1A is a front plan view of the cervical collar in its flatposition.

FIG. 1B is an edge view of the cervical collar in its flat position.

FIG. 1C is a side perspective view of the cervical collar with the chinsupport brace in its bowed forward position.

FIG. 2 is the elongated neck encircling band of the cervical collar.

FIG. 3 is an exploded side view of the chin support brace of thecervical collar.

FIG. 4 is a side view of the j-shaped element of the two part chinsupport brace of the cervical collar.

FIG. 5 is a side view of the two part chin support brace of the improvedcervical collar with an alternative locking feature.

FIG. 6A is a front plan view of the sternum and shoulder brace of thecervical collar.

FIG. 6B is an end view of the sternum and shoulder brace of the cervicalcollar.

FIG. 7A is an edge view of the locking mechanism showing the ratchetteeth and pawl system where downward movement of the sternum andshoulder brace is permitted.

FIG. 7B is an edge view of the locking mechanism showing the ratchetteeth and pawl system where upward movement of the sternum and shoulderbrace is permitted.

FIG. 7C is an edge view of the locking mechanism showing the ratchetteeth and pawl system where no movement of the sternum and shoulderbrace is permitted.

FIG. 8A is the front plan view of the cover piece of the cervicalcollar.

FIG. 8B is a side view of the cover piece of the cervical collar.

FIG. 9 is the slide piece containing a pawl for use with the cervicalcollar.

FIG. 10 is a front plan view of an alternative embodiment of thecervical collar in its flat position.

FIG. 11A is a front plan view of the alternative embodiment of theelongated neck encircling band in its flat position with sternum andshoulder brace.

FIG. 11B is an edge view of the alternative embodiment of the elongatedneck encircling band with sternum and shoulder brace.

FIG. 12A is a front plan view of the chin support height adjustmentpiece of the alternative embodiment of the cervical collar in its flatposition.

FIG. 12B is an edge view of the chin support height adjustment piece ofthe alternative embodiment of the cervical collar in its flat position.

FIG. 13 is an exploded side view of one embodiment of the chin supportbrace of the alternative embodiment of the cervical collar.

FIG. 14 is a side view of the j-shaped element of the two part chinsupport brace of the alternative embodiment of the cervical collar.

FIG. 15 is a side view of the two part chin support brace of thealternative embodiment of the improved cervical collar with analternative locking feature.

FIG. 16A is an edge view of the alternative embodiment of the lockingmechanism showing the ratchet teeth and pawl system where downwardmovement of the sternum and shoulder brace is permitted.

FIG. 16B is an edge view of the alternative embodiment of the lockingmechanism showing the ratchet teeth and pawl system where upwardmovement of the sternum and shoulder brace is permitted.

FIG. 16C is an edge view of the alternative embodiment of the lockingmechanism showing the ratchet teeth and pawl system where no movement ofthe sternum and shoulder brace is permitted.

FIG. 17A is the front plan view of the alternative embodiment of thecover piece of the cervical collar.

FIG. 17B is a side view of the alternative embodiment of the cover pieceof the cervical collar.

FIG. 18 is the slide piece of the alternative embodiment containing apawl for use with the cervical collar.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Although the invention is adaptable to a wide variety of uses, it isshown in the accompanying drawings for purpose of illustration asembodied in the improved cervical collar (10) comprised of an elongatedneck encircling band (12), a chin support brace (14) and an adjustablesternum and shoulder brace (15) with adjustment system for adjusting theheight of the sternum and shoulder brace in relation to the elongatedneck encircling band (12). See FIG. 1A.

The elongated neck encircling band (12) is formed from a stiff, plasticsheet material such as high density polyethylene, polyvinyl chloride orother such stiff, sturdy plastic material. The elements of the cervicalcollar may be die cut, extruded or prepared from molds as isconventional in the industry. For comfort there may be secured to theinner surface of this stiff plastic at various locations soft, foam typepads (13) which are comprised of conventional soft plastic material.These soft plastic pads are secured to the stiff plastic material by anyconventional securing means such as an adhesive or snap fasteners. It ispreferred that these foam pads be secured by cement or other adhesive toreduce the number of parts of the cervical collar (10).

The elongated neck encircling band (12) is preferably of one-piececonstruction generally comprised of a frontal portion (16) a backportion (18), a back side portion (20) and a front end portion (22). SeeFIG. 2. The elongated neck encircling band (12) is asymmetrical indesign with the frontal portion (16) attached to, and an integral partof, the back portion (18).

The frontal portion (16), which has affixed to it the chin support brace(14), will be placed against the user of the cervical collar on thefront portion of the user's neck under the user's chin. The back portion(18) of the cervical collar (10) is generally affixed to the back of theuser's neck. The back side portion (20) and the front end portion (22)are integral elements of the neck encircling band (12) located at eachend and are generally secured together after the improved cervicalcollar is secured to the wearer. See FIG. 2.

The frontal portion (16) when placed flat is generally curvilinear indesign, curving downward and then generally curving back upward from thefront end portion (22) to the back portion (18) with an oppositelongitudinal curved edge which runs from one side of the frontal portionto the other side. See FIG. 2. The lower curved edge (24) of the frontalportion is discontinued at that point where a cut-out section (26),which in use overlaps the Adams' apple or larynx of the wearer isformed, to permit a tracheotomy to be performed through the cut-outsection (26) with the cervical collar (10) in place. The upper curvededge (28) of the frontal portion (16) runs roughly parallel to the lowercurved edge (24) except that it is not discontinued as with the lowercurved edge (24).

Secured to the upper curved edge (28) is a chin support tab (30)extending upward away from the upper curved edge (28) of the frontalportion. This chin support tab (30) is used to secure the chin supportbrace (14) to the frontal portion (16) of the neck encircling band (12).See FIGS. 1A and 2.

Secured to one side of the frontal portion and an integral part of thecervical collar is the back portion (18) of the cervical collar (10).The back portion (18) can be of any conventional shape from generallyrectangular to generally oval. The back portion (18) of the elongatedneck encircling band (12) contains a number of vertical elongated slots(32) and cooperating slits (34) to make the neck encircling band (12)more flexible. These slots (32) are generally cut-out sections containedin the body of the back portion (18) running horizontally from nearwhere the frontal portion (16) joins the back portion (18) to theopposite side of the back portion. These slots (32) are generallylocated in the body of the back portion (18) running approximately halfway the distance between the top and the bottom of the back portion(18). The height and width of these slots is not critical but should beof sufficient size to permit enhanced flexibility and bending of theelongated neck encircling band (12). Preferably these slots are at leastabout 2 inches in height and about 1/4 inch in width.

The cooperating slits (34) are inscribed into the top and bottom edgesof the back portion (18) and extend part of the way into the backportion. The extent of the extension of these slits (34) is not criticalalthough it should not reach the slots (32). The slits (34) preferablyare at least about a 1/2 to 1 inch or so in length. These slots (32) andslits (34) should be arranged in such a manner as to provide adequateflexibility and bendability to the back portion (18) of the elongatedneck encircling band (12) without impacting on the structural integrityof the cervical collar (10).

An integral part of the back portion (18) located distal from thefrontal portion (16) is the back side portion (20). This back sideportion (20) is generally an elongated tab extending from the body ofthe back portion, and integrally connected to the back portion (18). Inan alternative embodiment the back side portion (18) merges into theback portion and is eliminated as a discrete element of the device. Anumber of elongated slots (36) similar to those contained in the body ofthe back portion (18) may be provided in this back side portion (20).Distal from the back side portion (20) of the elongated neck encirclingband (12) is the front end portion (22) which extends out from thefrontal portion (16). It acts in concert with the back side portion (20)when the cervical collar is placed around a user's neck. The frontal endportion (22) is also generally only a tab of generally rectangular shapeextending from the body of the frontal portion (16) of the cervicalcollar. In an alternative embodiment the front end portion (22) mergesinto the frontal portion (16) and is eliminated as a discrete element ofthe device. A collar retaining means is added to the elongatedencircling band to assist in the securing of the back side portion (20)to the front end portion (22) to hold the improved cervical collar (10)securely in place.

The collar retaining means can be any choice of straps or fastenerswhich will hold the improved cervical collar (10) together. For example,in a preferred embodiment an elongated hook and loop fastener (40) issecured to the back portion (18) and the back side portion (20) of thecervical collar through selected elongated slots (36) on the back sideportion (20) and also the body of the back portion. See FIG. 1A.Corresponding hook and loop fasteners (42) which interact with the hookand loop fasteners strip (40) are secured to the surface of the frontalend portion (22) and the front portion (16) by conventional securingmethods, such as adhesives, to permit the hook and loop fasteners strip(40) when encountering the hook and loop fasteners (42) to hold theimproved cervical collar (10) securely in place.

The second major element of the cervical collar is the chin supportbrace. As previously stated, the chin support brace may be a separateelement from the elongated neck encircling band or it may be formed asone integral piece of the chin support brace, permanently secured to theelongated neck encircling band. The chin support brace can be aconventional preformed, bowed forward chin support brace or, in analternative embodiment, the chin support brace can be adjustable andformed from two separate elements.

If a two-piece construction is utilized, the two pieces of the chinsupport brace are a j-shaped element (44) and a curved element (46). SeeFIG. 3. They are constructed from the same type of stiff plasticmaterial as is the elongated neck encircling band (12). The j-shapedelement (44) and the curved element (46) are similar in constructionexcept the j-shaped element has an additional end section (48) whichextends the length of the j-shaped element. The second end (50) of thej-shaped element which is distal from the end section (48) and thesecond end (52) of the curved element (46) are secured at separatelocations to the back side of the frontal portion (16) of the elongatedneck encircling band. See FIG. 1A. These two second ends are heldsecurely in place by any conventional securing means such as a pin whichextends through the surface of the elongated neck encircling band (12)and through the appropriate second ends of the j-shaped element (44) andthe curved element (46). They can be permanently secured in place, forexample, by rivets or snap fasteners (54).

The curved element (40) and the j-shaped element (44) are also securedto the chin support tab (30) of the frontal portion (16). The first end(56) of the curved element and a portion (58) of the j-shaped element(44), which portion is located close to the end section (48) of thej-shaped element (44), are secured to the chin support tab (30) of thefrontal portion (16) of the elongated neck encircling band (12). SeeFIG. 1A. They are secured to the chin support tab (30) by a securingdevice (60) similar to the securing devices (54) used to secure thesecond end (50) of the j-shaped element and the second end (52) of thecurved portion to the frontal portion (16). This second securing device(60) may be a pin, rivet or snap fastener. However, whenever a secondsecuring device (60) is chosen, it is required that this second securingdevice (60) permit rotation of the j-shaped element (44) and curvedelement (46) about the axis of the second securing device (60) securedto the chin support tab (30).

Secured to the end section (48) of the j-shaped element (44) is themeans for holding the chin support brace in a bowed forward position.Any conventional means for locking the two elements in a bowed forwardposition may be used. Preferably the means for holding is a lockingdevice (62) for locking the two elements of the chin support bracetogether in a bowed forward position after they are rotated about theaxis of the chin support tab (30). See FIG. 3. When each of theseelements of the chin support brace are rotated about the axis of thetab, the end section (48) of the j-shaped element (44) rotates upwardand forward until its top edge is above the top edge of the curvedelement (46). As both rotate, the top surface of each of the chinsupport elements bows forward to provide the support for the chin of thewearer. As these chin support elements are rotated, each side of thefrontal end portion (16) will also rotate backward to form the frontalsupport of the improved cervical collar. After both the j-shaped element(44) and the curved elements (46) are rotated to their bowed forwardposition, the locking device (62) holds them in this bowed forwardposition. In a preferred embodiment this locking device (62) is ac-shaped locking device element with a top hook portion (64) and abottom snap portion (66) which are integral parts of the j-shapedelement. See FIGS. 3 and 4. The second end (52) of the curved chinsupport element hooks under the top hook portion (64) of the c-shapedlocking device and above the bottom snap portion (66). The top of thecurved chin support slides under the top hook portion (64) of thelocking device and snaps in place under the bottom snap portion (66) ofthe locking device (62) to hold the two piece chin support brace in itsbowed forward position. See FIG. 1C.

In an alternative preferred embodiment, the means for holding the chinsupport brace in a bowed forward position is comprised of a hook and tabpiece (68) secured to the j-shaped element (44) which will fit into aslot (70) in the second end of the curved element (46) to hold the chinsupport elements in their bowed forward position. See FIG. 5.

The third element of the cervical collar is the sternum and shoulderbrace (15). See FIGS. 6A, 6B and 1. The sternum and shoulder brace isadjustably secured to the frontal portion of the elongated neckencircling band. Its shape is roughly similar to shape of the frontalportion except where the frontal portion forms the cut-out section (26).As previously stated, the lower curved edge (24) of the frontal portionis discontinued at the point where the cut-out section overlaps thelarynx. At that same cut-out section (26) the lower curved edge (72) ofthe sternum and shoulder brace (15) continues in a form roughly parallelwith the upper curved edge (28) of the elongated neck encircling band,but located instead at the lower curved edge of the sternum and shoulderbrace. In addition, at the location where the upper curved edge of thesternum and shoulder brace meets the cut-out section, the upper curvededge (74) of the sternum and shoulder brace is discontinued. By thisdesign the cut-out section (26) continues uninterrupted from theelongated neck encircling band (28) to the sternum and shoulder brace(15). By this arrangement the cut-out section extends uninterruptedregardless of the adjustment of the height of the sternum and shoulderbrace (15) in relation to the elongated neck encircling band (112) thusproviding at least one aperture which exposes the neck muscles at thelevel of the Adam's apple or larynx regardless of adjustment to theheight of the sternum and shoulder brace.

Located on each side edge of the cut-out section (26) is a positivealignment tracking means comprised of an overlap section (76) of thesternum and shoulder brace. See FIGS. 1A, 1B, 6A and 6B. This overlapsection (76) extends over and around the side edges (78) of the frontalportion of the elongated neck encircling band which form the cut-outsection (26). This overlap section (76) is located on each side edge(78) of the cut-out section (26) such that as the sternum and shoulderbrace moves vertically upward and downward, the overlap section (76)rests against the side edges (78) of the frontal portion (16) of theelongated neck encircling band (12). As the sternum and shoulder braceis extended downward, the overlap section rests securely against thecut-out section. This arrangement prevents the elongated neck encirclingband (12) from twisting out of parallel alignment as the sternum andshoulder brace (15) is extended downward. Any movement by one side ofthe sternum and shoulder brace downward will automatically result in acorresponding and parallel movement downward on the opposite side of thesternum and shoulder brace (15). By this arrangement it is assured thatthe sternum and shoulder brace will always extend downward equally onboth the left and the right side automatically.

The sternum and shoulder brace (15) is preferably located behind thefrontal portion (16) of the elongated encircling band when the cervicalcollar is viewed from the front. The sternum and shoulder brace (15) isdesigned to be approximately the same size of the frontal portion (16)and the front end portion (22) of the elongated neck encircling band(12). In particular, when the sternum and shoulder brace is securedbehind the frontal portion (16) of the elongated neck encircling band,the sternum and shoulder brace generally does not overlap other sectionsof the elongated neck encircling band (12). By this arrangement the backportion (18) of the elongated neck encircling band can be placed againstthe patient's neck and the sternum and shoulder brace (15) can beadjusted without moving the back portion (18) of the elongated neckencircling band (12).

The sternum and shoulder brace (15) slides up and down behind thefrontal portion (16) of the elongated neck encircling band on aplurality of posts (80) which ride within slots (82) either in the bodyof the frontal portion (16) of the elongated encircling band or the bodyof the sternum and shoulder brace (15) or both. Preferably, a pair ofslots (82) is provided on either side of the cut-out section (26) in thesternum and shoulder brace which operate in cooperation with a pair ofposts (80) secured to the frontal portion (16) of the elongated neckencircling band on either side of the cut-out section (26). Appropriaterivets and heads for the posts are utilized to hold the sternum andshoulder brace in place while still permitting the sliding movement ofthe sternum and shoulder brace. In addition, preferably a second pair ofvertical slots (84) is provided in the elongated neck encircling bandcloser to the cut-out section (26) than the first pair of slots. SeeFIGS. 1A, 6A and 6B. Appropriate posts with rivets and head s operate inconjunction with these slots to permit the sternum and shoulder brace tomove vertically in relation to the frontal portion (16) of the elongatedneck encircling band. The combination of those four slots and postsoperating in conjunction with the overlap sections (76) to permit thesternum and shoulder brace to move smoothly, vertically in relation tothe frontal portion (16) of the elongated neck encircling band. By thisadjustment mechanism, an appropriate distance between the patient'ssternum and shoulder and the underside of the patient's jaw at the chincan be maintained which will effectively support the patient's jaw. Bymodifying the location of the sternum and shoulder brace (15) as itrelates to the elongated neck encircling band (12) on the patient,adequate support for the patient's neck can be achieved.

While the location of the sternum and shoulder brace (15) can beadjusted vertically by this system of slots and posts, it is necessarythat the precise location of the sternum and shoulder brace (15) inrelation to the frontal portion (16) of the elongated neck encirclingband (12) be fixed by a locking mechanism which will prevent the sternumand shoulder brace (15) from collapsing under pressure from the patient.This positive locking system can be any of a number of existing systems.However, preferably, a new ratchet teeth system (86) is utilized toprovide this positive locking system. See FIG. 1A.

In one preferred embodiment the ratchet teeth system (86) is designed topermit the sternum and shoulder brace (15) of the cervical collar to beextended downwardly but not to allow it to ascend after its extension.This type of positive locking system is quick to use and provides safetyfor the patient. In this preferred system, one or preferably a pair ofrows of ratchet teeth (88) is secured to the outer surface of theelongated neck encircling band, preferably one of each is located oneither side of the second set of slots (84) on the frontal portion (16)of the elongated neck encircling band (12). These rows of ratchet teeth(88) are cut such that a pawl (90) located in a cover piece (92) whichcovers the ratchet teeth will permit downward movement of the sternumand shoulder brace only. See FIG. 7A. Upward movement of the sternum andshoulder brace (15) is prevented by the interaction of the pawl (90)with the ratchet teeth. The cover piece (92) which covers and holds thepawl can be any conventional design such that it will move in relationto the ratchet teeth in line with the movement of the sternum andshoulder brace itself. In one embodiment the cover piece is secured atits top portion to the sternum and shoulder brace as an element of thepost which passes through the slot (84) and at its bottom portion by asecond post with rivet and hook secured to the sternum and shoulderbrace. Various other arrangements can be conceived all within theconfines of the instant invention. Preferably, the pawl (90) will belocated within a slot (96) in the cover piece (92). See FIGS. 8A and 8B.As the cover piece (92) moves vertically in relation to the first set ofratchet teeth (88), this allows the pawl (90) to move vertically inrelation to the first set of ratchet teeth (88). This permits the teeth(98) of the pawl to slide over the first set of ratchet teeth (88)interacting therewith.

As an improvement on this system the pawl (90) can be located on aseparate slide piece (100) slidably secured within the cover piece (92)such that the pawl (90) may be pulled out of line with the first set ofratchet teeth (88), thus permitting the sternum and shoulder brace (15)to move upward as well as downward. See FIG. 9. Preferably, the slidepiece (100) is engaged in a system which will lock the teeth of the pawlin place preventing vertical movement of the sternum and shoulder brace(15) after the sternum and shoulder brace has been secured to thepatient but which can be slidably adjusted to permit the movement of thesternum and shoulder brace upward after it is removed from the patient.

As a further improvement upon this system a second group of ratchetteeth (102) is cut into the surface of the frontal portion (16) of theelongated neck encircling band (12) running in a row parallel to thefirst set of ratchet teeth rows (88) previously discussed. See FIG. 1Aand FIGS. 7A, 7B and 7C. The direction of the cut of this second row ofratchet teeth (102) is reversed from the cut of the previously discussedratchet teeth. This second group of ratchet teeth (102) are angled inthe opposite direction from the first set of ratchet teeth. With thisarrangement the cover piece (92) also contains a second pawl (104), thedirection of the cut of the teeth of which is also reversed from that ofthe first pawl (90). This second pawl (104) is movable so that it can bemoved into and out of alignment with the second set of ratchet teeth(102). Thus, when the second pawl (104) and the second set of ratchetteeth (102) are aligned, movement of the sternum and shoulder brace isprevented in the direction opposite from the movement prevented by thefirst set of ratchet teeth (88) and first pawl (90). See FIG. 7B.Preferably, when this second set of ratchet teeth (102) and second pawl(104) are engaged, they will prevent the sternum and shoulder brace frombeing further extended downward. If the first set of ratchet teeth (88)and the first pawl (90) are also engaged, this arrangement provides acomplete locking system for the sternum and shoulder brace, thuspreventing not only retrograde movement vertically but also additionalmovement downward of the sternum and shoulder brace. See FIG. 7C.

In this alternative embodiment it is critical that both sets of pawls(90, 104) be moveable horizontally so that each pawl can not only beengaged with the appropriate ratchet teeth to prevent movement in onedirection but that each pawl can be moved horizontally out of alignmentwith the corresponding ratchet teeth to permit appropriate verticalmovement of the sternum and shoulder brace. By having the pawlsindependently moveable in a horizontal direction within the cover piece(92), the greatest degree of adjustment capacity for the sternum andshoulder brace is provided while at the same time providing a positivelocking of the sternum and shoulder brace in place. The alternativearrangements are shown in FIGS. 7A, 7B and 7C. In FIG. 7A the first setof ratchet teeth rows (88) are lined up with the first pawl (90). Withthis arrangement of the pawl and ratchet teeth, the sternum and shoulderbrace (15) can be extended downward moving the sternum and shoulderbrace closer to the patient's chest. Retrograde movement upward isprevented by the interaction of the first set of ratchet teeth (88) andthe first pawl (90). In this embodiment the second pawl and the secondset of ratchet teeth (102) are not in alignment. Once the correctposition of the sternum and shoulder brace is achieved for the patient,the second pawl (104) is moved in a horizontal direction until it is inalignment with the second set of ratchet teeth (102). See FIG. 7C. Atthis point the sternum and shoulder brace can neither move furtherdownward nor can it move upward. Moving the first pawl (90) out ofalignment with the first set of ratchet teeth rows (88) will permit thesternum and shoulder brace to be retracted upward. See FIG. 7B. Once theprecise location for the sternum and shoulder brace (15) in relation thefrontal portion (16) of the elongated neck encircling band is achieved,both pawls are placed in alignment with their respective ratchet teeththus preventing any further movement of the sternum and shoulder brace.See FIG. 7C.

Preferably the set of pawls are arranged in a positive locking systemsuch that they will be locked in alignment with the respective ratchetteeth. In one embodiment of this system, each set of pawls (90, 104) hasattached to its outside edge a tab system which will assist in lockingthe pawls into a predetermined height after final adjustment of thelocation of the sternum and shoulder brace of the cervical collar. Anumber of different tab systems can be utilized. In one preferredembodiment, the outside end of each pawl attaches to a tab (106) whichis rotatably over the cover piece (92) and locks in place to the topsurface of the cover piece. When properly designed, these tabs will onlylock in position to the cover piece when the sternum and shoulder bracemay move neither upward nor downward. In this embodiment, both sets ofpawls will engage both sets of ratchet teeth rows to lock the sternumand shoulder brace (15) securely in place. Other systems can be designedwhich will lock the cooperating pawls and ratchet teeth in place, all ofwhich are covered by this invention.

In the preferred system, a pair of ratchet teeth rows run vertically onboth sides of one of the slots. Within this slot is the post which holdsthe cover piece (92) over the locking system and which is secured to theback side of the sternum and shoulder brace. Preferably the two sets ofratchet teeth rows are located one on either side of the slot (84).These ratchet teeth (88), when operating with the corresponding pawl(90), permit the sternum and shoulder brace to extend downward but donot permit it to move back upward. A third row of ratchet teeth (102) islocated outside of the first two rows of ratchet teeth away from thecut-out section (26). These ratchet teeth are cut with the oppositeangle from the teeth in the first two rows. This third row of ratchetteeth (102) when operating in conjunction with a cooperating reversepawl (104) prevent further extension of the sternum and shoulder bracedownward from the elongated neck encircling band. See FIG. 1A.

In an alternative embodiment an alternative improved cervical collar(110) is comprised of an elongated neck encircling band (112) containingas an integral element thereof a sternum and shoulder brace (115), achin support height adjustment piece (117) and a chin support brace(114) with an adjustment system for adjusting the height of the chinsupport brace in relation to the elongated neck encircling band (112).See FIG. 10.

The elongated neck encircling band (112) is formed from a stiff, plasticsheet material such as high density polyethylene, polyvinyl chloride orother such stiff, sturdy plastic material. The elements of the cervicalcollar may be die cut, extruded or prepared from molds as isconventional in the industry. For comfort there may be secured to theinner surface of this stiff plastic at various locations soft, foam typepads (not shown) which are comprised of conventional soft plasticmaterial. These soft plastic pads are secured to the stiff plasticmaterial by any conventional securing means such as an adhesive or snapfasteners. It is preferred that these foam pads be secured by cement orother adhesive to reduce the number of parts of the cervical collar(110).

The elongated neck encircling band (12) is preferably of one-piececonstruction generally comprised of a sternum and shoulder brace (115),a back portion (118), a back side portion (120) and a front end portion(122). See FIGS. 11A and 11B. The elongated neck encircling band (112)is asymmetrical in design.

The sternum and shoulder brace (115) when placed flat is generallycurvilinear in design, curving downward and then generally curving backupward from the front end portion (122) to the back portion (118) withan opposite longitudinal curved edge which runs from one side of thefrontal portion to the other side. See FIG. 11A. The upper curved edge(128) of the sternum and shoulder brace is discontinued at that pointwhere a cut-out section (126), which in use overlaps the Adam's apple orlarynx of the wearer is formed, to permit a tracheotomy to be performedthrough the cut-out section (126) with the cervical collar (110) inplace. The lower curved edge (124) of the sternum and shoulder brace(115) runs roughly parallel to the upper curved edge (128) except thatit is not discontinued as with the upper curved edge (128).

Secured to one side of the chin support height adjustment piece (117)and an integral part of the cervical collar is the back portion (118) ofthe cervical collar (110). The back portion (118) can be of anyconventional shape from generally rectangle to generally oval. The backportion (118) of the elongated neck encircling band (112) contains anumber of vertical elongated slots (132) and cooperating slits (134) tomake the neck encircling band (112) more flexible. These slots (132) aregenerally cut-out sections contained in the body of the back portion(118) running horizontally from near where the sternum and shoulderbrace (115) joins the back portion (118) to the opposite side of theback portion. These slots (132) are generally located in the body of theback portion (118) running approximately half way the distance betweenthe top and the bottom of the back portion (118). The height and widthof these slots is not critical but should be of sufficient size topermit enhanced flexibility and bending of the elongated neck encirclingband (112). Preferably these slots are at least about 2 inches in heightand about 1/4 inch in width.

The cooperating slits (134) are inscribed into the top and bottom edgesof the back portion (118) and extend part of the way into the backportion. The extent of the extension of these slits (134) is notcritical although it should not reach the slots (132). The slits (134)preferably are at least about a 1/2 to 1 inch or so in length. Theseslots (132) and slits (134) should be arranged in such a manner as toprovide adequate flexibility and bendability to the back portion (118)of the elongated neck encircling band (112) without impacting on thestructural integrity of the cervical collar (110).

An integral part of the back portion (118) located distal from thesternum and shoulder brace (115) is the back side portion (120). Thisback side portion (120) is generally an elongated tab extending from thebody of the back portion, and integrally connected to the back portion(118). In an alternative embodiment the back side portion (118) mergesinto the back portion and is eliminated as a discrete element of thedevice. A number of elongated slots (136) similar to those contained inthe body of the back portion (118) may be provided in this back sideportion (120). Distal from the back side portion (120) of the elongatedneck encircling band (112) is the front end portion (122) which extendsout from the sternum and shoulder brace (115). It acts in concert withthe back side portion (120) when the cervical collar is placed around auser's neck. The frontal end portion (122) is also generally only a tabof generally rectangular shape extending from the sternum and shoulderbrace (115) of the cervical collar. In an alternative embodiment thefront end portion (122) merges into the sternum and shoulder brace (115)and is eliminated as a discrete element of the device. A collarretaining means is added to the elongated encircling band to assist inthe securing of the back side portion (120) to the front end portion(122) to hold the improved cervical collar (110) securely in place.

The collar retaining means can be any choice of straps or fastenerswhich will hold the improved cervical collar (110) together. Forexample, in a preferred embodiment an elongated hook and loop fastener(140) is secured to the back portion (118) and the back side portion(120) of the cervical collar through selected elongated slots (136) onthe back side portion (120) and also the body of the back portion. SeeFIG. 10. Corresponding hook and loop fasteners (142) which interact withthe hook and loop fasteners strip (140) are secured to the surface ofthe frontal end portion (122) and the sternum and shoulder brace (115)by conventional securing methods, such as adhesives, to permit the hookand loop fasteners strip (140) when encountering the hook and loopfasteners (142) to hold the improved cervical collar (110) securely inplace.

The sternum and shoulder brace (115) is an integral part of theelongated neck encircling band (112). The shape of the sternum andshoulder brace is roughly similar in shape of the chin support heightadjustment piece (117) except where the sternum and shoulder brace formsthe cut-out section (126). The upper curved edge (128) of the sternumand shoulder brace (115) is discontinued at the point where the cut-outsection (126) overlaps the larynx. At that same cut-out section (126)the upper curved edge (172) of the chin support height adjustment piece(117) continues in a form roughly parallel with the lower curved edge(124) of the sternum and shoulder brace (115). In addition, at thelocation where the lower curved edge of the chin support heightadjustment piece (117) meets the cut-out section, the lower curved edge(174) of the chin support height adjustment piece (117) is discontinued.By this design the cut-out section (126) continues uninterrupted fromthe chin support height adjustment piece (117) to the sternum andshoulder brace (115). By this arrangement the cut-out section extendsuninterrupted regardless of the adjustment of the height of the sternumand shoulder brace (115) in relation to the chin support heightadjustment piece (117) thus providing at least one aperture whichexposes the neck muscles at the level of the Adam's apple or larynxregardless of the adjustment to the height of the sternum and shoulderbrace.

Located on each side edge of the cut-out section (126) is a positivealignment tracking means comprised of an overlap section (176) of thechin support height adjustment piece (117). See FIGS. 10 and 12A. Thisoverlap section (176) extends over and around the side edges (178) ofthe sternum and shoulder brace (115) of the elongated neck encirclingband which form the cut-out section (126). This overlap section (176) islocated on each side edge (178) of the cut-out section (126) such thatas the chin support height adjustment piece (117) moves verticallyupward and downward, the overlap section (176) rests against the sideedges (178) of the sternum and shoulder brace (115). As the sternum andshoulder brace is extended downward, the overlap section (176) restssecurely against the cut-out section. This arrangement prevents thesternum and shoulder brace (115) from twisting out of parallel alignmentas the chin support height adjustment piece (117) is extended upward.Any movement by one side of the sternum and shoulder brace downward willautomatically result in a corresponding and parallel movement downwardon the opposite side of the sternum and shoulder brace (115). By thisarrangement it is assured that the sternum and shoulder brace willalways extend downward equally on both the left and the right sideautomatically.

Located behind the sternum and shoulder brace (115) of the elongatedencircling band when the cervical collar is viewed from the front is thechin support height adjustment piece (117). The chin support heightadjustment piece (117) is designed to be approximately the same size asthe combined sternum and shoulder brace (115) and the front end portion(122) of the elongated neck encircling band (112). The chin supportheight adjustment piece (117) has an upper curvilinear edge (172) whichruns approximately parallel to the upper curved edge (128) of thesternum and shoulder brace. In addition, the lower curved edge (174) ofthe chin support height adjustment piece runs approximately parallel tothe lower curved edge (124) of the sternum and shoulder brace. Aspreviously stated, at the point where the lower curved edge (174) of thechin support height adjustment piece meets the cut-out section (126) thelower curved edge is discontinued. Thus, the cut-out section (126)extends uninterrupted regardless of the adjustment of the height of thesternum and shoulder brace (115) in relation to the chin support heightadjustment piece (117), thus providing at least one aperture whichexposes the neck muscles at the level of the Adam's apple or larynxregardless of the adjustment to the height of the sternum and shoulderbrace.

Secured to the upper curved edge (172) of the chin support heightadjustment piece (117) is a chin support tab (130) extending upward awayfrom the upper curved edge (172). This chin support tab (130) is used tosecure the chin support brace (114) to the chin support heightadjustment piece (117). See FIGS. 10 and 12A.

The chin support height adjustment piece (117) slides up and down behindthe sternum and shoulder brace (115) of the elongated neck encirclingband on a plurality of posts (180) which ride within slots (182) eitherin the body of the sternum and shoulder brace (115) of the elongatedencircling band or the body of the chin support height adjustment piece(117) or both. Preferably, a pair of slots (182) are provided on eitherside of the cut-out section (126) in the sternum and shoulder brace(115) which operate in cooperation with a pair of posts (180) slidablysecured to the sternum and shoulder brace (115) of the elongated neckencircling band on either side of the cut-out section (126). Appropriaterivets and heads for the posts are utilized to hold the chin supportheight adjustment piece (117) in place while still permitting thesliding movement of the sternum and shoulder brace (115). In addition,preferably a second pair of vertical slots (184) is provided in thesternum and shoulder brace (115) closer to the cut-out section (126)than the first pair of slots. See FIGS. 10 and 11A. Appropriate postswith rivets and heads operate in conjunction with these slots to permitthe chin support height adjustment piece (117) to move vertically inrelation to the sternum and shoulder brace (115) of the elongated neckencircling band. The combination of those four slots and posts operatingin conjunction with the overlap sections (176) to permit the chinsupport height adjustment piece to move smoothly, vertically in relationto the sternum and shoulder brace of the elongated neck encircling band.By this adjustment mechanism, an appropriate distance between thepatient's sternum and shoulder and the underside of the patient's jaw atthe chin can be maintained which will effectively support the patient'sjaw. By modifying the location of the chin support height adjustmentpiece (117) on the patient as it relates to the elongated neckencircling band (112), adequate support for the patient's neck can beachieved.

While the location of the sternum and shoulder brace (115) can beadjusted vertically by this system of slots and posts, it is necessarythat the precise location of the sternum and shoulder brace (115) inrelation to the chin support height adjustment piece (117) be fixed by alocking mechanism which will prevent the sternum and shoulder brace(115) from collapsing under pressure from the patient. This positivelocking system can be any of a number of existing systems. However,preferably, a new ratchet teeth system (186) is utilized to provide thispositive locking system. See FIGS. 10, 16A, 16B and 16C.

In one preferred embodiment the ratchet teeth system (186) is designedto permit the sternum and shoulder brace (115) of the cervical collar tobe extended downwardly but not to allow it to ascend after itsextension. This type of positive locking system is quick to use andprovides safety for the patient. In this preferred system, one orpreferably a pair of rows of ratchet teeth (188) are secured to theouter surface of the elongated neck encircling band, preferable one ofeach is located on either side of the second set of slots (184) on thesternum and shoulder brace (115) of the elongated neck encircling band(112). These rows of ratchet teeth (188) are cut such that a pawl (190)located in a cover piece (192) which covers the ratchet teeth willpermit downward movement of the sternum and shoulder brace only. SeeFIGS. 10 and 16A. Upward movement of the sternum and shoulder brace(115) is prevented by the interaction of the pawl (190) with the ratchetteeth. The cover piece (192) which covers and holds the pawl can be anyconventional design such that it will move in relation to the ratchetteeth in line with the movement of the sternum and shoulder braceitself. In one embodiment the top portion of the cover piece is securedto the chin support height adjustment piece (117) as an element of thepost which passes through the slot (184) and at its bottom portion by asecond post with rivet and hook secured to the chin support heightadjustment piece. Various other arrangements can be conceived all withinthe confines of the instant invention. Preferably, the pawl (190) willbe located within a slot (196) in the cover piece (192). See FIGS. 16A,16B, 16C, 17A and 17B. As the cover piece (192) moves vertically inrelation to the first set of ratchet teeth (188), this allows the pawl(190) to move vertically in relation to the first set of ratchet teeth(188). This permits the teeth (198) of the pawl to slide over the firstset of ratchet teeth (188) interacting therewith.

As an improvement on this system the pawl (190) can be located on aseparate slide piece (200) slidably secured within the cover piece (192)such that the pawl (190) may be pulled out of line with the first set ofratchet teeth (188), thus permitting the sternum and shoulder brace(115) to move upward as well as downward. See FIGS. 16A, 16B, 16C and18. Preferably, the slide piece (200) is engaged in a system which willlock the teeth of the pawl in place preventing vertical movement of thesternum and shoulder brace (115) after the sternum and shoulder bracehas been secured to the patient but which can be slidably adjusted topermit the movement of the sternum and shoulder brace upward after it isremoved from the patient.

As a further improvement upon this system a second group of ratchetteeth (202) is cut into the surface of the elongated neck encirclingband (112) running in a row parallel to the first set of ratchet teethrows (188) previously discussed. See FIGS. 10 and 11A. The direction ofthe cut of this second row of ratchet teeth (202) is reversed from thecut of the previously discussed ratchet teeth. This second group ofratchet teeth (202) are angled in the opposite direction from the firstset of ratchet teeth. With this arrangement the cover piece (192) alsocontains a second pawl (204), the direction of the cut of the teeth ofwhich is also reversed from that of the first pawl (190). This secondpawl (204) is movable so that it can be moved into and out of alignmentwith the second set of ratchet teeth (202). Thus, when the second pawl(204) and the second set of ratchet teeth (202) are aligned, movement ofthe sternum and shoulder brace is prevented in the direction oppositefrom the movement prevented by the first set of ratchet teeth (188) andfirst pawl (190). See FIG. 16B. Preferably, when this second set ofratchet teeth (202) and second pawl (204) are engaged, they will preventthe sternum and shoulder brace from being further extended downward. Ifthe first set of ratchet teeth (188) and the first pawl (190) are alsoengaged, this arrangement provides a complete locking system for thesternum and shoulder brace, thus preventing not only retrograde movementvertically but also additional movement downward of the sternum andshoulder brace. See FIG. 16C.

In this alternative embodiment it is critical that both sets of pawls(190, 204) be moveable horizontally so that each pawl can not only beengaged with the appropriate ratchet teeth to prevent movement in onedirection but that each pawl can be moved horizontally out of alignmentwith the corresponding ratchet teeth to permit appropriate verticalmovement of the sternum and shoulder brace. By having the pawlsindependently moveable in a horizontal direction within the cover piece(192), the greatest degree of adjustment capacity for the sternum andshoulder brace is provided while at the same time providing a positivelocking of the sternum and shoulder brace in place. The alternativearrangements are shown in FIGS. 16A, 16B and 16C. In FIG. 16A the firstset of ratchet teeth rows (188) are lined up with the first pawl (190).With this arrangement of the pawl and ratchet teeth, the sternum andshoulder brace (115) can be extended downward moving the sternum andshoulder brace closer to the patient's chest. Retrograde movement upwardis prevented by the interaction of the first set of ratchet teeth (188)and the first pawl (190). In this embodiment the second pawl and thesecond set of ratchet teeth (202) are not in alignment. Once the correctposition of the sternum and shoulder brace is achieved for the patient,the second pawl (204) is moved in a horizontal direction until it is inalignment with the second set of ratchet teeth (202). See FIG. 16C. Atthis point the sternum and shoulder brace can neither move furtherdownward nor can it move upward. Moving the first pawl (190) out ofalignment with the first set of ratchet teeth rows (188) will permit thesternum and shoulder brace to be retracted upward. See FIG. 16B. Oncethe precise location for the sternum and shoulder brace (115) inrelation the chin support height adjustment piece (117) is achieved,both pawls are placed in alignment with their respective ratchet teeththus preventing any further movement of the sternum and shoulder brace.See FIG. 16C.

Preferably the set of pawls are arranged in a positive locking systemsuch that they will be locked in alignment with the respective ratchetteeth. In one embodiment of this system, each set of pawls (190, 204)has attached to its outside edge a tab system which will assist inlocking the pawls into a predetermined height after final adjustment ofthe location of the sternum and shoulder brace of the cervical collar. Anumber of different tab systems can be utilized. In one preferredembodiment, the outside end of each pawl attaches to a tab (206) whichis rotatably over the cover piece (192) and locks in place to the topsurface of the cover piece. When properly designed, these tabs will onlylock in position to the cover piece when the sternum and shoulder bracemay move neither upward nor downward. In this embodiment, both sets ofpawls will engage both sets of ratchet teeth rows to lock the sternumand shoulder brace (115) securely in place. Other systems can bedesigned which will lock the cooperating pawls and ratchet teeth inplace, all of which are covered by this invention.

In the preferred system, a pair of ratchet teeth rows run vertically onboth sides of one of the slots. Within this slot is the post which holdsthe cover piece (192) over the locking system and which is secured tothe back side of the chin support height adjustment piece (117).Preferably the two sets of ratchet teeth rows are located one on eitherside of the slot (184). These ratchet teeth (188), when operating withthe corresponding pawl (190), permit the sternum and shoulder brace toextend downward but do not permit it to move back upward. A third row ofratchet teeth (202) is located outside of the first two rows of ratchetteeth away from the cut-out section (126). These ratchet teeth are cutwith the opposite angle from the teeth in the first two rows. This thirdrow of ratchet teeth (202) when operating in conjunction with acooperating reverse pawl (204) prevent further extension of the sternumand shoulder brace downward from the elongated neck encircling band.

The third major element of the cervical collar is the chin supportbrace. As previously stated, the chin support brace may be a separateelement from the chin support height adjustment piece (117) or it may beformed as one integral piece permanently secured to the chin supportheight adjustment piece. The chin support brace can be a conventionalpreformed, bowed forward chin support brace or, in an alternativeembodiment, the chin support brace can be adjustable and formed from twoseparate elements.

If a two-piece construction is utilized, the two pieces of the chinsupport brace are a j-shaped element (144) and a curved element (146).See FIG. 13. They are constructed from the same type of stiff plasticmaterial as is the elongated neck encircling band (112). The j-shapedelement (144) and the curved element (146) are similar in constructionexcept the j-shaped element has an additional end section (148) whichextends the length of the j-shaped element. The second end (150) of thej-shaped element which is distal from the end section (148) and thesecond end (152) of the curved element (146) are secured at separatelocations to the back side of the chin support height adjustment piece(117). See FIG. 10. These two second ends are held securely in place byany conventional securing means such as a pin which extends through thesurface of the chin support height adjustment piece (117) and throughthe appropriate second ends of the j-shaped element (144) and the curvedelement (146). They can be permanently secured in place, for example, byrivets or snap fasteners (154).

The curved element (140) and the j-shaped element (144) are also securedto the chin support tab (130) of the chin support height adjustmentpiece (117). The first end (156) of the curved element and a portion(158) of the j-shaped element (144), which portion is located close tothe end section (148) of the j-shaped element (144), are secured to thechin support tab (130) of the chin support height adjustment piece(117). See FIG. 10. They are secured to the chin support tab (130) by asecuring device (160) similar to the securing devices (154) used tosecure the second end (150) of the j-shaped element and the second end(152) of the curved portion to the chin support height adjustment piece(117). This second securing device (160) may be a pin, rivet or snapfastener. However, whenever a second securing device (160) is chosen, itis required that this second securing device (160) permit rotation ofthe j-shaped element (144) and curved element (146) about the axis ofthe second securing device (160) secured to the chin support tab (130).

Secured to the end section (148) of the j-shaped element (144) is themeans for holding the chin support brace in a bowed forward position.Any conventional means for locking the two elements in a bowed forwardposition may be used. Preferably the means for holding is a lockingdevice (162) for locking the two elements of the chin support bracetogether in a bowed forward position after they are rotated about theaxis of the chin support tab (130). See FIG. 13. When each of theseelements of the chin support brace are rotated about the axis of thetab, the end section (148) of the j-shaped element (144) rotates upwardand forward until its top edge is above the top edge of the curvedelement (146). As both rotate, the top surface of each of the chinsupport elements bows forward to provide the support for the chin of thewearer. As these chin support elements are rotated, each side of thechin support height adjustment piece (117) will also rotate backward toform the frontal support of the improved cervical collar. After both thej-shaped element (144) and the curved elements (146) are rotated totheir bowed forward position, the locking device (162) holds them inthis bowed forward position. In a preferred embodiment this lockingdevice (162) is a c-shaped locking device element with a top hookportion (164) and a bottom snap portion (166) which are integral partsof the j-shaped element. See FIGS. 13 and 14. The second end (152) ofthe curved chin support element hooks under the top hook portion (164)of the c-shaped locking device and above the bottom snap portion (166).The top of the curved chin support slides under the top hook portion(164) of the locking device and snaps in place under the bottom snapportion (166) of the locking device (162) to hold the two piece chinsupport brace in its bowed forward position.

In an alternative preferred embodiment, the means for holding the chinsupport brace in a bowed forward position is comprised of a hook and tabpiece (168) secured to the j-shaped element (144) which will fit into aslot (170) in the second end of the curved element (146) to hold thechin support elements in their bowed forward position. See FIG. 15.

In operation, when the first embodiment of the cervical collar is to beused, the back portion (18) of the elongated neck encircling band iswrapped around the back of the patient's neck. The frontal portion (16)is held in place against the patient's neck and chest. The collarretaining element such, as an elongated hook and loop fastener (40)which is attached to the back side portion (20), is secured firmly inplace against one or more hook and loop fasteners (42) which are securedto the frontal end portion (22) and, if necessary, on the top surface ofthe frontal portion of the elongated neck encircling band. If thecervical collar does not have a two-piece adjustable chin support, asingle piece chin support is placed against the patient's neck. If atwo-piece adjustable chin support is an element, the various elements ofthe curved chin support are rotated and formed into a bowed forwardposition using the appropriate locking systems. This results in the chinsupport brace being bowed forward to more easily support the wearer'schin. The respective pawls (90, 104) are slid to a position whichpermits the sternum and shoulder brace to be pulled downward until it isfirmly in place against the patient's sternum. If a single set ofratchet teeth rows (88) and pawl (90) are present, no further operationis necessary. However, if a reverse ratchet teeth (102) and reverse pawl(104) is present, the tab (106) secured to the reverse pawl is pulledsuch that the reverse pawl (104) and the row of reverse ratchet teeth(102) interact, thus preventing further downward movement of the sternumand shoulder brace. Tabs (106) connected to both pawls are then lockedin place against the cover piece (92). By this mechanism additionalupward or additional downward movement of the sternum and shoulder braceis prevented. After the user no longer needs the cervical collar, thehook and loop material strip used as a collar retaining element isremoved from the fasteners attached to the frontal portion and thefrontal end portion. This removes the cervical collar from the patient'sneck.

In operation in the alternative embodiment, when the cervical collar isto be used, the back portion (118) of the elongated neck encircling bandis wrapped around the back of the patient's neck. The sternum andshoulder brace (115) is held in place against the patient's chest. Thecollar retaining element such, as an elongated hook and loop fastener(140) which is attached to the back side portion (120), is securedfirmly in place against one or more hook and loop fasteners (142) whichare secured to the frontal end portion (122) and, if necessary, on thetop surface of the frontal portion of the elongated neck encirclingband. If the cervical collar does not have a two-piece adjustable chinsupport, a single piece chin support is placed against the patient'sneck. If a two-piece adjustable chin support is an element, the variouselements of the curved chin support are rotated and formed into a bowedforward position using the appropriate locking systems. This results inthe chin support brace being bowed forward to more easily support thewearer's chin. The respective pawls (190, 204) are slid to a positionwhich permits the chin support brace (114) secured to the chin supportheight adjustment piece (117) to be pulled upward until it is firmly inplace against the patient's chin. If a single set of ratchet teeth rows(188) and pawl (190) are present, no further operation is necessary.However, if a reverse ratchet teeth (202) and reverse pawl (204) ispresent, the tab (206) secured to the reverse pawl is pulled such thatthe reverse pawl (204) and the row of reverse ratchet teeth (202)interact, thus preventing further upward movement of the sternum andshoulder brace. Tabs (206) connected to both pawls are then locked inplace against the cover piece (192). By this mechanism additional upwardor downward movement of the sternum and shoulder brace is prevented.After the user no longer needs the cervical collar, the hook and loopmaterial strip used as a collar retaining element is removed from thefasteners attached to the frontal portion and the frontal end portion.This removes the cervical collar from the patient's neck.

I claim:
 1. An adjustable cervical collar comprising:(a) a chin supportbrace, and (b) an adjustment system means secured to said chin supportbrace and adjustably secured to an asymmetrical elongated neckencircling band opposite said chin support brace, said elongated neckencircling band containing as an integral element thereof a sternum andshoulder brace, whereby the height of the chin support brace can beadjusted relative to the elongated neck encircling band.
 2. The collarof claim 1 further comprising a positive alignment means secured to thechin support brace for maintaining the chin support brace in parallelalignment with the elongated neck encircling band as the height of thechin support brace is adjusted in relation to the elongated neckencircling band.
 3. The collar of claim 2 wherein the adjustment systemmeans is a chin support height adjustment piece.
 4. The collar of claim3 wherein the chin support brace is a separate element from the chinsupport height adjustment piece.
 5. The collar of claim 4 wherein thechin support brace is a preformed, bowed forward chin support brace. 6.The collar of claim 3 wherein the chin support brace is formed as oneintegral piece permanently secured to the chin support height adjustmentpiece.
 7. The collar of claim 6 wherein the chin support brace is apreformed, bowed forward chin support brace.
 8. The collar of claim 1wherein the adjustment system means is a chin support height adjustmentpiece.
 9. The collar of claim 8 wherein the chin support brace is aseparate element from the chin support height adjustment piece.
 10. Thecollar of claim 4 wherein the chin support brace is a preformed, bowedforward chin support brace.
 11. The collar of claim 8 wherein the chinsupport brace is formed as one integral piece permanently secured to thechin support height adjustment piece.
 12. The collar of claim 11 whereinthe chin support brace is a preformed, bowed forward chin support brace.13. The collar of claim 1 wherein the elongated neck encircling band isof one piece construction and further comprises a back portion, a backside portion, and a front end portion.
 14. The collar of claim 13wherein the elongated neck encircling band, including the integralsternum and shoulder brace, and the chin support brace, when securedtogether, are capable of being bent from a flat condition to a conditionencircling the neck of a wearer.
 15. The collar of claim 14 wherein thesternum and shoulder brace when placed flat is curvilinear in design,curving downward and then curving back upward from the front end portionto the back portion with an opposite longitudinal curved edge that runsfrom one side of the front end portion to the other side.
 16. The collarof claim 14 wherein the parallel alignment is maintained between saidsecured together chin support brace and said elongated neck encirclingband in both said flat condition and said condition encircling the neckof said wearer.
 17. The collar of claim 13 wherein the back portion issecured to one side of the adjustment system means.
 18. The collar ofclaim 13 wherein the back side portion is an integral part of the backportion and located distal from the sternum and shoulder brace.
 19. Thecollar of claim 13 wherein the front end portion extends out from thesternum and shoulder brace and is distal from the back side portion. 20.The collar of claim 1 wherein the chin support brace is a two-piece chinsupport brace comprised of a first and a second chin support elementwherein each chin support element has a first and second end where thefirst end of each said first and second chin support element is securedin place to the elongated neck encircling band and second ends of eachsaid first and second chin support element are rotatably secured to theneck encircling band wherein the second and first chin support elementoverlaps the second end of the second chin support element to permit thetwo-piece chin support brace to be held in bowed forward position.